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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700368
Report Date: 05/19/2021
Date Signed: 05/19/2021 03:29:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:COMMONS ON THORNTON, THEFACILITY NUMBER:
392700368
ADMINISTRATOR:MILLER, CAROLFACILITY TYPE:
740
ADDRESS:10711 THORNTON RDTELEPHONE:
(209) 476-1500
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:110CENSUS: 94DATE:
05/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Carol Miller, Executive DirectorTIME COMPLETED:
12:00 PM
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On 05/19/2021 at 8:40am, Licensing Program Analyst (LPA) T. White spoke with Business Office Manager, Deborah Warren regarding facility risk assessment questions. Business Office Manager confirmed no staff or residents have experienced symptoms within the last 10 days. At 10:05am, LPA T. White arrived unannounced to conduct a required 1-year annual inspection. LPA met with Executive Director, Carol Miller and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 110 non-ambulatory residents, which 10 may be bedridden and 25 may be on hospice.

LPA toured the facility including but not limited to apartments, bathrooms, kitchen, dining room area, common area and courtyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature throughout the facility is maintained at 76 degrees Fahrenheit. LPA observed lighting in apartments are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ apartment bathrooms was measured at 117 degrees and 114 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid floors. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

LPA observed smoke detectors and carbon monoxide are interconnected with the fire department. Fire extinguisher was last serviced on 05/05/2021. Emergency Disaster Plan was last posted on 05/04/2021. First aid kit was observed to be complete. Fire drill was last conducted on 04/20/2021.

Report continues on 809C.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Treana WhiteTELEPHONE: (510) 566-9342
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: COMMONS ON THORNTON, THE
FACILITY NUMBER: 392700368
VISIT DATE: 05/19/2021
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Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 06/04/2021:

LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 500 Personnel Report
LIC 610E Emergency Disaster Plan
Current Administrator’s Certificate

No deficiencies cited during inspection.

Exit interview conducted with Executive Director and a copy of report emailed to Executive Director.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Treana WhiteTELEPHONE: (510) 566-9342
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC809 (FAS) - (06/04)
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